Association of Take-Home Naloxone and Opioid Overdose Reversals Performed by Patients in an Opioid Treatment Program

Source:

Katzman JG, Takeda MY, Greenberg N, et al. Association of Take-Home Naloxone and Opioid Overdose Reversals Performed by Patients in an Opioid Treatment Program. JAMA Netw Open. 2020;3(2):e200117. doi:10.1001/jamanetworkopen.2020.0117

Key Points

Question  Is there a benefit associated with take-home naloxone for overdose reversals supplied to patients who are receiving treatment for opioid use disorder?

Findings  This year-long cohort study enrolled 395 study participants and provided overdose education and take-home naloxone kits. After 1 year, 73 participants performed 114 opioid overdose reversals in the community.

Meaning  These findings suggest that take-home naloxone supplied to patients in opioid treatment programs may be part of a targeted harm-reduction strategy to reduce negative outcomes associated with opioid overdose in the community.

Abstract

Importance  The US opioid crisis was deemed a public health emergency in 2017. More than 130 individuals in the US die daily as a result of unintentional opioid overdose deaths.

Objective  To measure use of take-home naloxone for overdose reversals performed by study participants with opioid use disorder receiving treatment at an opioid treatment program.

Design, Setting, and Participants  In a year-long cohort study, between April 4, 2016, and May 16, 2017, 395 study participants enrolled at the University of New Mexico Addiction and Substance Abuse Opioid Treatment Program, an outpatient clinic treating substance use disorders. Inclusion criteria included all patients enrolled at University of New Mexico Addiction and Substance Abuse Opioid Treatment Program during the study enrollment period; positive history of opioid use disorder treated with methadone, buprenorphine, or naltrexone; and age 18 years or older. Exclusion criteria included allergy to naloxone and age younger than 18 years. The study closed 1 year after enrollment, on May 17, 2018. Data analysis was performed from May 2018 to July 2019.

Exposure  Two doses of take-home naloxone combined with opioid overdose education were provided to study participants.

Main Outcomes and Measures  The primary outcome was to measure the association of take-home naloxone with overdose reversals performed by patients with opioid use disorder enrolled in an opioid treatment program.

Results  We enrolled 395 study participants (270 female [68.4%]; mean [SD] age, 35.4 [12.6] years; 260 [65.8%] with Hispanic white race/ethnicity) in the 1-year prospective trial. Sixty-eight female participants (25.2% of all female participants) were pregnant at the time of enrollment. Seventy-three of the 395 study participants (18.0%) performed 114 overdose reversals in the community. All community reversals were heroin related. Most study participants (86.8%) stated that the person on whom they performed an overdose reversal was a friend, relative, acquaintance, or significant other. In the year before enrollment, only 18 study participants (4.5%) had been prescribed naloxone.

Conclusions and Relevance  Take-home naloxone as part of overdose education and naloxone distribution provided to patients in an opioid treatment program may be associated with a strategic targeted harm reduction response for reversing opioid overdose–related deaths. Policy makers may consider regulations to mandate overdose education and naloxone distribution in opioid treatment programs.